Generation Rx: Taking action on teen prescription drug abuse

CrossCurrents

By Lesley Young

Linda Gardiner knows first hand the dangers of prescription opioids – drugs prescribed to manage chronic or severe pain. She blames addiction to high-prescribed dosages of OxyContin, one such pain reliever, in the death of her son Chad, who took his own life in 2004, in part, because he felt he had nowhere to turn for help. Chad, 26 at the time, became addicted to the opioid over a one-year period after it was prescribed to treat pain from back injuries sustained in a car accident. “He wanted to be remembered for who he was and not for who he had become,” says Gardiner. “He was ashamed at the desperation of it all.”

This tragedy has motivated Gardiner to raise awareness of opioid abuse by sharing her story and listening to others through her web site, oxyabusekills.ca. She often hears from other parents who are struggling with a child’s abuse of OxyContin, children often much younger than Chad was.

Their stories reflect recently emerging trends in prescription opioid abuse among teens in Canada and the United States. The Ontario Student Drug Use and Health Survey (OSDUHS), the longest ongoing survey of adolescent drug use in Canada, in 2007, looked for the first time at prescription opioid abuse among teens. The study, conducted by the Centre for Addiction and Mental Health (CAMH) in Toronto, found that 21 per cent of students in grades 7 to 12 admitted to taking a prescription opioid for non-medical purposes within the previous year. Just over three-quarters said they got the drugs at home. In 2007, the number of students who reported using OxyContin doubled from the 2005 survey to two per cent. Also disconcerting is the possible link between opioid abuse and abuse of other drugs. A study of U.S. elementary and high school students published in Pediatrics in 2006 found evidence that the non-medical use of prescription medications, particularly opioids, may be associated with an increase in general substance abuse problems.

Since awareness of the problem is relatively new, yet the threat of abuse is, literally, close to home, health care professionals and policy-makers are grappling with ways to prevent prescription opioid abuse among youth. Generally, there is a feeling that once more is understood about the problem, appropriate policies, including anti-diversion strategies and prescription drug monitoring programs, can be developed. Education and awareness among youth and parents are also key, but few such programs exist.

Easy access is a big issue. “North America has an enormous abundance of psychoactive drugs coming through the medical system,” says Benedikt Fischer, director of the Illicit Drugs, Public Health and Policy Unit at the Centre for Addictions Research of British Columbia. “We prescribe more prescription opioids that any other country or region in the world,” he says, pointing out that Canada is the world’s top per capita consumer of a number of opioids. Fischer says policy is required to alleviate the flooding, but that finding practical solutions is a real challenge.

Gary Roberts, senior advisor with the Canadian Association for School Health in Ottawa, says that despite regulations in Canada forbidding direct-to-consumer prescription drug advertising (ads can only name a drug or what it treats, not both), American spillover and the Internet render the law ineffective.

Part of the lure and danger of youth abuse of prescription drugs is the false belief that because they are legal and prescription-based, they are safe. “Young people must be informed that abusing prescribed medication can be just as dangerous as using illicit street drugs,” says Gail Czukar, president of the Canadian Executive Council on Addictions (CECA). “We need more research on the extent and nature of prescription drug abuse in Canada. We need to determine what monitoring and anti-diversion strategies will best address this growing problem,” adds Czukar, who is also vice-president of Policy, Education and Health Promotion at CAMH. CECA called for greater policy focus on prescription opioid abuse (including diversion onto to the illegal market) in the federal government’s new National Anti-Drug Strategy announced in early 2007. The strategy is criticized for focusing on high-profile illegal drugs and failing to provide support for harm reduction strategies.

Unfortunately, there is very little research on anti-diversion strategies, according to a 2007 editorial in Addiction, which made some recommendations based on what research exists in Australia, the United Kingdom and the United States. It found that strategies that aim to identify individuals at high risk of diversion or abuse are much more costly and likely to have a lower health impact than strategies that identify liberal prescribers (there are fewer prescribers and there is a paper trail). The editorial also suggests that professional regulation may be a more effective deterrent if it results in more immediate action such as loss of entitlement to prescribe, as in the U.S., compared to a finding of professional misconduct by tribunal, as in Canada.

Experts agree that better ways of monitoring diversions are also needed. In Canada, only a few provinces have prescription monitoring programs in place, according to a 2006 article in the Canadian Association Medical Journal. Nova Scotia is one of them. It recently implemented a new online system in pharmacies throughout the provinces, providing pharmacists, physicians and the Nova Scotia Prescription Monitoring Program with real-time data on prescribing and use of monitored drugs.

As for youth abuse of opioids, Fischer says we know even less. “Before we can do anything in the system we need to gather more evidence to understand what is behind these phenomena,” he says. “Is it a substitution effect from other illicit drugs? Are these people self-medicating? Or is it simply that there is an increase in availability sitting around in people’s medicine cabinets?”

Whatever the answer, the sooner problem users can be identified, especially among youth, the more that can be done to treat them, says Fischer, who would like to see tools developed for identifying abuse for school settings. The fact that many students get the prescription opioids from home indicates that teen prescription opioid abuse cannot be dealt with as an isolated phenomenon, says Fischer. “This behaviour happens in the wider context of the social environment. There are many stressors and factors at work that make it tempting for people to resort to prescriptions drugs.”

Action is already underway through the Community Partnership on Drug Abuse in Cape Breton, Nova Scotia. Initially formed in 2004 to be a six- to nine-month committee to address the increase in OxyContin use in Cape Breton, the partnership is now entering its fourth year. The infrastructure turned out to be an effective grassroots way to deal with various substance abuse issues, including youth prevention, says the partnership’s executive director, Marilyn O’Neil. “It’s such a simple and effective idea – to have police, health authorities and educators at all secondary and post-secondary school levels, doctors and pharmacists and parents of addicts all sitting at the same table.” The integrated approach to active problem-solving has been tremendous, she adds.

The partnership consists of three working groups – education and prevention, treatment and community safety – reporting to a steering committee on which sit senior members of various key organizations, for example, the CEO of the Nova Scotia District Health Authorities and the Chief of Police. This way, when working groups present to the committee, the very people responsible for initiating change, such as obtaining funding, are able to put recommendations into action. The group has also been strong on the government lobby front, being the driver behind putting the Nova Scotia Prescription Monitoring Program online.

The partnership recognizes the importance of including youth themselves in developing effective prevention and education strategies. The partnership held a youth summit last year, where 40 youth met to talk about drug abuse and drug messaging. Action coming out of the summit includes the development of a permanent youth committee and the launch later this year of an education web site for youth.

The partnership is also currently implementing a program called Asset Building for Communities, developed by the U.S. Search Institute. The first phase involves surveying the youth of Cape Breton to discern where they are in terms of “assets.” “There is a strong correlation between the number of assets students have and how successful and prosperous their lives are,” says O’Neil. Once deficits are determined, programs such as peer mentoring will be developed to help build assets, such as strong social supports and better grades at school. “With assets, kids have more going for them so they are better able to cope when things aren’t going their way, and so they know who to talk to and where to get resources when they need them,” says O’Neil.

With prescription opioid abuse among youth emerging as a trend across the country, the hope is that action to address the issue will gain momentum. Education and awareness campaigns, alongside strong anti-diversion policies and drug monitoring programs, may be the best way to keep prescription opioids where they belong – in the medicine cabinet.

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